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� <br />SITE ADDRESS <br />i�MIT APPLICATION <br />CITY OF EVERETT PERMIY SERVICES <br />3200 CEDAR STREET, EVERETT, WA 96201, 4?_5-257-8810 <br />PARCEL TAX I.D. # <br />DESC. � I I <br />OWNER ADDRESS <br />/l�v��� ��:�K��� `I Kz0 M.3 <br />TENANT NAME i CUNTACT NAME <br />I <br />CONTRACTOR <br />PHONE <br />PROPOSED USE OF BUILDING <br />PERMIT <br />TYPE <br />{/v�,�, <br />CONTRACT PRICE OF WORK <br />WORKDESCRIPTION /N 5%ALL N/OO,d <br />C�1/+an�j/. <br />NO. I TYFE OF FIXTURE OR ITEM <br />WATER CLOSET <br />BATHTU6 <br />LAVATORY (WASH BASIN) <br />SHOWER <br />KITCHEN SINK 8 DISPOSAL <br />D�SHWASHER <br />IAUNDRY TRAY <br />CLOTHES WASHER <br />URINAL <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />BACKFLOW PREVENTER <br />SINK (SERVICE/BAR/MOP/ETC.) <br />OTHER <br />ADDRESS <br />PERMIT N <br />(U� v /�7 �f -< <br />PHONE <br />�LS -Z70' S S: <br />PHONE <br />CONTR. LICENSE # <br />�Building j'j Mechanical n Addition I HEAT SOURCE <br />Cambination ����} Plumbing \NORK ��S Alteration Electric <br />Demolition � Sign TYPE t� New Gas <br />Sprinkler � RepairlMnint. Other <br />CITY OF EVERETT LOCAL SALES TAX C�O�E IS 3105 <br />sio •r,�� iN�T�� �Ni.�t�(+4'j ,F�FMa✓B rk/ST/�Vb ,8/ZIc/G <br />N0. I TYPE OF FIXTURE OR ITEM <br />A/C — AlHANDLING UNITS <br />FOFCED AIR SYSTEMS <br />HEAT PUMP <br />UNI"i HEATERS <br />CLOTHES DRYER <br />RANGE HOOD <br />WATER HEATER <br />METAL FIREPLACE/STOVE <br />FIREPLACE INSERT <br />GAS FIREPLACE <br />GAS RANGE <br />GAS PIPING <br />EXHAUST FAN <br />OTHER <br />I HEREBY CERITIFY THAT I HAVE READ A�D EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br />PROVISIONS OF IAWS AND ORIDINACES LOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHEfHER SPECIFIED IIEREIN OR <br />NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION OF ANY OTHER <br />STATE OR LOCAL LAW REGULATING CONSTFiUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORI2ED BY THE <br />OWNER OF THIS PROPERTY TO PERFpfiM TJiE WORK FOR WHICH APPLICATION IS MADE AND I COMPLY WITH THE STATE <br />CONTRACTORS LAW 18 �7 RCW AfJ 296.200 C. <br />�� � �.1 � �/� �J- iJ � <br />